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January 23, 2013

Collateral Damage

A Pain in the Hip

by Corey Dawkins and Stephani Bee

Alex Rodriguez
Rodriguez finally underwent surgery on his left hip, and even though it went as expected, he’ll probably be out until mid-July. During the arthroscopic surgery, three small incisions were made for the instruments before Dr. Bryan Kelley addressed a cam impingement, a torn labrum, a cyst, and cartilage damage. It's not the worst possible scenario, but it's a lot of things to fix in one procedure.

Last year, Ben and I authored a mini-series focusing on common baseball injuries. One of the best-received articles covered hip injuries, focusing on impingement with labral tears—a condition that is becoming increasingly more prevalent in all athletes. You can read that article here. A quick recap: The labrum is a ring of cartilage that deepens the socket for the femoral head to stay in. Cam lesions are bumps off the femoral head that develop over time. The x-ray below illustrates this more clearly:

When the leg is brought up and twisted inward, the femoral head will contact the labrum above it and the rim of the hip socket. At some point during extreme motion, bones will make contact, but in cases of cam impingement, it occurs earlier in the motion. Because of this earlier contact, Rodriguez was more prone to tearing his labrum and cartilage damage.

This was not something that developed overnight, or even over the course of the 2012 season. It developed gradually and likely began back when A-Rod was a teenager. Why has he been able to produce at a high level? The body will do almost anything to reach a goal. In this case, Rodriguez’s body allowed the joint to get into a position to create enough force to rapidly rotate his hip at least 50 times per day during the season.

Over time, the labrum roughens and a tear develops. Before you know it, the articular cartilage softens and wears down, which is the area of greatest concern. For all the advances in medicine, there is still not an optimal method of repairing articular cartilage after injury or osteoarthritis of this nature. Rodriguez was somewhat lucky because he had a significant tear in his labrum but minimal articular cartilage damage.

His recovery is going to take most, if not all, of the first half of the season. In 2009, he didn't have a cam lesion burred down, so he was able to return eight weeks after his surgery. In order to determine how much to burr down, the surgeon moves the leg around during surgery, looking to see how severe the impingement is. The extra bone is burred down, temporarily weakening the area until it fully remodels, which takes a while. If the bone was not such an important weight-bearing bone, it might not be an issue, but a fracture in the femoral neck where the bone is burred down could have disastrous outcomes.